Ovarian Cancer: What's New?
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Each year ovarian cancer experts from across the nation gather at the Society of Gynecologic Oncology Conference. Stephanie Blank, MD, Director of Gynecologic Oncology, Mt. Sinai Health System, will report back from the conference on what the research presented there means for patients.
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1) A study in Brazil found that HPV prevalence in young primiparous women was 58.5%, with 17.3% and 13.3% positive for the two high-risk HPV types 16 and 18. This suggests that postpartum vaccination could provide protection against cervical cancer for most women.
2) A US study found high acceptance of postpartum HPV vaccination, with 97% of women satisfied with the choice and 98% finding it convenient. However, only 30.7% completed the full three-dose vaccination series.
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Post partum period an excellent opportunity for hpv vaccination
1) A study in Brazil found that HPV prevalence in young primiparous women was 58.5%, with 17.3% and 13.3% positive for the two high-risk HPV types 16 and 18. This suggests that postpartum vaccination could provide protection against cervical cancer for many women.
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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- 1. Ovarian Cancer: What’s New Stephanie V. Blank, MD Professor, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai Director of Gynecologic Oncology for the Mount Sinai Health System
- 2. Disclosures • No financial disclosures • Research collaborations with Roche, Tesaro, Astra Zeneca, Merck • Will be discussing off label uses of various agents • (tried something new)
- 3. SGO 2019 Themes • 50 years of progress • Parp inhibitors • Immunotherapy • New combinations • Risk reducing salpingectomy
- 15. Tolerating PARP inhibitors • TWIST: PFS without toxicity due to nausea, vomiting and fatigue • How to tailor dosing • Good for all ages
- 17. PARPi after PARPi • Clinical benefit rate: over 70% • BRCA mutation carriers: 85% • Prior exposure to PARPi does not necessarily confer resistance to future PARPi • Toxicity after initial PARPi was not associated with toxicity after second PARPi
- 18. SGO 2019
- 19. Different ways of looking at results • Disease control rate • Overall survival more important than progression free survival • Importance of composite endpoints—not only how long, but how well
- 47. IOM 2016 Ovarian Cancer: Evolving Paradigms in Research and Care
- 52. Negative trials • Javelin: PLD +/- avelumab for recurrent ovarian cancer • PLD +/- trabectedin for recurrent ovarian cancer
Editor's Notes
- poly ADP ribose polymerase